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Ophthalmic manifestations of Cryptococcus gattii species complex:a case series and review of the literature

International Journal of Ophthalmology(English edition) 2022年第1期15卷 119-127页

作者： Grace A.McCabe Jack W.McHugh todd goodwin Douglas F.Johnson Anthony Fok Thomas G.Campbell Department of Ophthalmology the Royal Melbourne HospitalMelbourneVictoria 3050Australia Department of Internal Medicine Mayo ClinicRochesterMinnesota 55902USA James Cook University TownsvilleQueensland 4811Australia NQ Eye Foundation TownsvilleQueensland 4811Australia Department of Infectious Disease the Royal Melbourne HospitalMelbourneVictoria 3050Australia Department of Neurology the Royal Melbourne HospitalMelbourneVictoria 3050Australia Centre for Eye Research Australia East MelbourneVictoria 3002Australia Ophthalmology Department of Surgerythe University of MelbourneMelbourneVictoria 3010Australia

AIM:To report 4 cases of Cryptococcus gattii(C.gattii)species complex infection with diverse ophthalmic manifestations,and to review the literature to examine pathobiology of disease,classical ophthalmic presentations and outcomes,and treatment modalities for this emerging pathogen.METHODS:Cases of C.gattii meningoencephalitis with ophthalmic manifestations were identified via chart review at two institutions in Australia and one institution in the mid-west region of the United States and are reported as a case series.Additionally,a MEDLINE literature review was conducted to identify all reported cases of C.gattii with ophthalmic manifestations from 1990-2020.Cases were reviewed and tabulated,together with our series of patients,in this report.RESULTS:Four cases of C.gattii with ophthalmic manifestations are presented;three from Australia and one from the USA.A literature review identified a total of 331 cases of C.gattii with visual sequelae.The majority of cases occurred in immunocompetent individuals.Blurred vision and diplopia were the most common presenting symptoms,with papilloedema the most common sign,reported in 10%-50%of cases.Visual loss was reported in 10%-53%of cases,as compared to rates of visual loss of 1%-9%in C.neoformans infection.Elevated intracranial pressure,cerebrospinal fluid(CSF)fungal burden,and abnormal neurological exam at presentation correlated with poor visual outcomes.The mainstays of treatment are anti-fungal agents and aggressive management of intracranial hypertension with serial lumbar punctures.CSF diversion procedures should be considered for refractory cases.Acetazolamide and mannitol are associated with high complication rates,and adjuvant corticosteroids have demonstrated higher mortality rates;these treatments should be avoided.CONCLUSION:Permanent visual loss represents a devastating yet potentially preventable sequelae of C.gattii infection.Intracranial hypertension needs to be recognised early and aggressively managed.Referral to an ophthalmologist/neuro-ophthalmologist

关键词： Cryptococcus Cryptococcus gattii cryptococcosis ophthalmic manifestation

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